Chapter 41: Understanding Acute Forearm Compartment Syndrome

After reading this chapter you should be able to understand easy forearm anatomy, physiopathology of the acute forearm compartment syndrome, and incidence of this syndrome while recognizing preceding signs, and treating forearm hematomas.

Both radial and ulnar arteries and nerves run through the volar compartment of the forearm. This compartment contains the majority of flexor muscles responsible for the flexor movement of the hand and first finger. It is intercommunicated with a smaller compartment located at the dorsal position. The interosseous membrane and both the radius and ulna divide these two major anatomical compartments. The radial and ulnar arteries become more superficial at the wrist where they divide and finally converge into the deep and superficial palmar arches.

Bleeding, infection, or edema may increase tissue pressure within any of the compartments of the forearm. This increased pressure may be initially held up by leaking and spreading to other parts of the compartment. However, the maintenance of an elevated pressure inside the forearm (usually considered to be normal up to 9 mm Hg) within a limited expandable space starts a vicious circle of edema and lack of venous and lymphatic drainage that may eventually evolve toward irreversible damage of the muscular and nerve structures. The situation of an increased pressure within the forearm is known as acute forearm compartment syndrome (AFCS).

Helena Tizón-Marcos, MD, MsC